Editorial: A failed checkup for digital records

The federal pitch to move to electronic medical records came enveloped in promises of lower costs and better care.

It all sounded pretty good.

Recent reports, however, have raised questions about whether doctors and hospitals are using this new-found digital efficiency to cheat government-run Medicare and Medicaid programs.

Advertisement

Health and Human Services Secretary Kathleen Sebelius and Attorney General Eric Holder last week issued a stern warning to those who are using e-records and sophisticated software to "upcode" services in order to collect more from the government.

Promising vigorous investigations is a good start, but they need to take more systemic action.

The government should create an oversight system, something it failed to do when it began pushing the digital conversion with $30 billion in stimulus money to help doctors and hospitals buy equipment.

Monitoring the many different types of billing and medical software in use around the country is a complex but necessary task.

The American Medical Association has recommended federally mandated testing assuring that electronic billing systems are accurate and not structured to make upcoding easy.

The Office of Inspector General is investigating the matter, and that assessment of problems should be useful in devising solutions.

While the issue has been percolating as long as e-records have been debated, it came to prominence in recent weeks with reports from The New York Times and The Center for Public Integrity about potential electronic record abuses.

The Times, which examined Medicare data, asserted the move to e-records "may be contributing to billions of dollars in higher costs for Medicare, private insurers and patients."

The Times found hospitals had received $1 billion more in Medicare reimbursements in 2010 than they had five years previously, a rise at least partially attributable to changing billing codes for emergency room patients.

Another factor may be the ease with which providers can cut and paste treatment descriptions, and software prompting doctors to check a box saying a more thorough examination had occurred when perhaps it had not.

To be sure, Affordable Care Act reforms, which move from a fee-for-service model to one that pays fees based on outcomes, could help slow such abuses, and that's good.

A multi-pronged approach emphasizing oversight and systemic reimbursement revisions could go a long way toward minimizing fraud in this otherwise beneficial health care innovation.

We live in the digital age, and a change to electronic patient records was inevitable, but the use of these new systems to cheat must not be.